Subhepatic caecal tumour in an adult with intestinal malrotation

Intestinal malrotation is an abnormality that usually presents in infanthood. Following correction, complications are rare in adults. We describe a case of a 64-year-old woman with a history of malrotation who presented with anaemia and weight loss. Colonic cancer was apparently excluded by colonoscopy. In fact, endoscopy had only been performed up to the hepatic flexure, which was unexpectedly positioned in the right iliac fossa. The patient then underwent a CT pneumocolon study, which demonstrated a caecal tumour, unusually located subhepatically. Repeat colonoscopy was performed to the true caecum and the lesion was biopsied. The patient underwent uncomplicated open right hemicolectomy and made a full recovery. To avoid diagnostic delay and, at worst, missing pathology entirely, clinicians must always thoroughly review a patient's history. Adults with malrotation may have atypical presentations of abdominal disease and so it is pertinent that surgeons, endoscopists and general practitioners remain alert and cognisant of their patients' history.